How Can FSH Levels Affect Your Fertility?

Follicle-stimulating hormone (FSH) plays a major role in sexual development and reproduction in both males and females. Without adequate levels of this hormone, eggs and sperm cannot grow and develop properly.

Higher or lower FSH concentrations in the blood are often a sign of various medical issues and infertility. Along with AMH, FSH provides precious information about ovarian reserve and is, therefore, used as a biomarker of a woman’s reproductive capacity.

Follicle-stimulating hormone function

Originally used for the evaluation of ovarian reserve in fertility treatments, FSH is closely related to a woman’s reproductive potential. Secreted by the anterior pituitary gland (a small, oval-shaped gland located on the underside of the brain), FSH promotes normal ovarian function along with the luteinizing hormone (LH).

When should you take an FSH test?

If you have been struggling to conceive, your doctor will most likely arrange an FSH test. Abnormal levels of FSH may reveal medical and genetic conditions that can cause hormone problems. For women with irregular or absent periods, FSH can help confirm menopause.

A girl or boy who goes through puberty earlier or later than the normal age should also have FSH testing.

How is the FSH blood test performed?

For basic fertility workup, women should be tested on the third day of their menstrual cycle. This is because FSH is lowest at this stage of the cycle. Many doctors, however, may perform the test on any day between days 2 to 4 of the cycle.

Serum follicle-stimulating hormone levels are subject to fluctuations during the menstrual cycle and can’t be measured at any other time (except within the first few days of the menstrual period).

Additionally, FSH levels are affected by hormonal treatments and contraceptives. Therefore, FSH should notbe tested while using contraceptive methods (e.g. pills, implants, depo shot, intrauterine devices) and can be measured 1–2 months after stopping birth control.

Further testing

Since FSH presents only one aspect of a person’s reproductive health, further fertility evaluation may be required. To get a clearer picture of your hormone profile, a doctor may recommend the following hormone testing:

• Estradiol (E2)
• Luteinizing hormone (LH)
• Prolactin (PRL)
• Progesterone (PROG)
• Testosterone

What are the normal ranges for each age group?

There are no universal cutoff values for FSH, as these levels depend on a person’s age and sex. The follicle-stimulating hormone levels chart below shows the normal range by male and female age.

Women with FSH levels under 15 mIU/ml have better chances of conceiving, compared to those of women in the 15 mIU/ml to 24.9 mIU/ml range. FSH levels over 25 mIU/ml indicate a severely diminished ovarian reserve.

What does high FSH mean?

Elevated FSH generally indicates low ovarian reserve. With a decline in a woman’s egg count, another change comes into place: the reduction in the quality of the eggs being produced. As a result, the ability to get pregnant is limited.

Higher FSH levels may also indicate age-related infertility and subsequent onset of menopause.

Other possible explanations for abnormally high FSH levels include:

• Primary ovarian insufficiency (POI)
• Early menopause
• Tumour of the pituitary gland
• Turner syndrome

Fertility treatment for high FSH levels in females

Personalisation is the key to optimising reproductive care for patients with high FSH levels. For customised fertility treatment, doctors should look at the FSH range in the context of a woman’s age. These patients are usually recommended to try one of the following fertility treatments:

• In vitro fertilisation (IVF)
• Egg donation

In some instances, women with elevated FSH levels can achieve a successful pregnancy using their own eggs. However, if there are indications that IVF will be unsuccessful, egg donation may be advised.

What if my FSH levels are low?

Decreased FSH levels may impair ovarian function and lead to infertility. Possible reasons for low FSH hormone levels include:

• Pituitary dysfunction (and subsequent absence of ovulation)
• Kallman syndrome
• Hypothalamic problem
• Being severely underweight
• Excessive physical stress
• Long-term mental stress

Without sufficient levels of FSH, the ovaries lose the ability to release eggs, leading to infertility.

FSH deficiency in children may cause delayed puberty and underdeveloped reproductive organs. If you notice that your daughter hasn’t entered puberty by age 13 — or your son hasn’t by age 14 — speak with a doctor to arrange proper testing.

The role of FSH in male fertility

In men, FSH helps regulate testicular growth and sperm production. Without adequate levels of this hormone, it’s impossible to produce normal sperm. Having a low sperm count (oligospermia) or no sperm in the semen (azoospermia) may affect a man’s ability to conceive a baby.

Abnormal FSH levels

Men with underdeveloped testes — and those who have difficulties conceiving — should consider undergoing FSH blood testing. Inadequate levels of FSH may mean pituitary gland issues due to a medical condition or a disturbance within the hypothalamus-pituitary-gonad axis.

Testosterone supplements and anabolic steroids for bodybuilding can decrease FSH levels, causing male infertility. Men with a history of testosterone or anabolic steroid use are more likely to experience hormonal problems and should have FSH hormone testing.

Abnormally high results could point to a condition such as:

• Klinefelter syndrome
• Tumours in the pituitary gland
• Testicular failure (e.g. genetic condition, damaged caused by radiotherapy or chemotherapy)
• Male menopause

Low FSH levels may imply that the pituitary gland or hypothalamus aren’t functioning properly, which can lead to a problem with the endocrine feedback system.

Treatment for inadequate FSH levels in males

Treatment for male infertility related to FSH depends on the cause of the problem. Examples of possible FSH treatments include:

• Gonadotropin therapy (FSH and LH injections)
• In vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI)

Your health is in your hands!

FSH provides a small picture of your reproductive health and it shouldn’t be considered in isolation. An Anti-Mullerian Hormone (AMH) test, ultrasound, and antral follicle count (AFC) scan can provide a more detailed insight into the situation.

Booking a consultation with a reproductive specialist will help determine which kinds of testing and treatment are most appropriate for you. Remember: access to quality care is essential for addressing health problems that may come your way!

Originally published at https://blog.fertilityconnected.com on September 30, 2019.